Leading Causes of Life – Page 10

Faith with

Across the street from The Garfield Conservatory, a block away from the L, a gaggle of geese find their away amid the urban mysteries. — Across the street from The Garfield Conservatory, a block away from the L, a gaggle of geese find their way amid the urban mysteries.

There were years when I was across the ocean that I would tell people I was from Canada to avoid explaining US politics. People in more normal countries dumbfounded my people would be found dumb enough to vote for a California actor obviously reading someone else’s lines to fill the most intellectually demanding job in history. Some Americans still talk of him with reverence, which is hard to explain. But since we elected our Harvard lawyer, it’s been a lot easier to travel.

Its not any easier being a Christian than an American. I work in fields with lots of science going on so am occasionally held to account for my faith. Nobody cares enough enough to hurt me for it, as in olden days. But for those who otherwise like me (sometimes including my children), it bears explaining how an apparently intelligent person would identify as a member of Jesus’ or any tradition of faith. Like claiming Canada next door, it is easier to say something vaguely ethical rather than saying I go to that most odd of all human assemblies, a church.

Francis has helped. But even in a week in which it would really hard to screw up being a Christian, we have had nutters from Arkansas chattering away near microphones embarrassing generations of Christians. If Francis watched any TV while he was here last week, he probably thought about taking his robe off to just blend in with the homeless.

We think of programs as independent and accountable, but actually they weave, influencing each other and shaping the whole. — We think of our traditions and learning groups as independent and accountable, but actually they weave, influencing each other and shaping the whole.

I think of our traditions—mine being Christian—as learning groups more than knowing groups. My most powerful relationships are like that, such as the Africa Religious Health Assets Program (ARHAP) led by Jim Cochrane, Steve DeGruchy, Paul Germond and now Jill Olivier. A whole literature has emerged from its thoughtful journey, now thousands of pages. Groups don’t learn in a straight line and sometimes wander into dead ends (especially when they put on conferences with papers). But if we keep our learning grounded, we can find our way back out. AHRAP accumulated epic stories of finding, naming and mapping. But its most useful tools are those for optimistic searching (such as the assets mapping now about to be trusted by hospitals, public health and community partners in Tacoma).

That curious community spun off another one pursuing just one of its questions, about the Leading Causes of Life. Those Fellows cross the strangest boundaries of intellect and miles, as great questions always have and will draw us.

Stakeholder Health was originally the “Health Systems Learning Group” and remains useful when in learning mode. We’ve are drawn to the questions that lie in between hospitals and their neighborhoods, borrowing and bending the language of clinical, public and population health. The questions look technical, but draw us into deeper waters.

Technical kinds of answers are not the most interesting or obvious thing being learned. Along the way we have been learning about the defining characteristic of our group—most of us as both individuals and institutions were of faith. But not all of us are officially faith-ish, which is what makes the whole group so interesting. We’ve talked and sometimes argued about whether Stakeholder Health is “based” on has “faith.” What we mean by those words? Is it important? Does Henry Ford Health System have enough to count just because it has among the very largest network of faith community nurses in the nation? It reflects the man named Henry Ford, not Jesus, but sustains an often sacrificial mission finding innovations where a mere corporation would flee. What’s the name of that driving spirit? Most hospitals with religious names on their buildings don’t think or act any differently toward their patients, neighbors or employees—and many much worse—than massively profitable Cancer Centers of America. But some do find the wells of compassion to give their life away decade after decade. Iconic little Bon Secours in West Baltimore sure does and, yes, those are nuns all over that history, just as surely as the Pope is Catholic.

Many of our organizations are now merged and morphed—Brooklyn Lutheran part of staunchly secular academic NYU. The blended hospital and medical school called Wake Forest Baptist Medical Center will discover the cure for cancer before we figure out what to do with that middle word in our name. These complicated relationships are being carried by what we are learning, not by what we are based on; faith more like a sail to catch the spirit than anchor to hold us back.

We are who we walk with along our learning way. (Kevin, TC and me. Jim Cochrane holding the camera.)

People from outside hospitals notice that interesting things are happening inside. Peter Berger edited a special edition of “Society” looking at the complicated dynamics of faith in modern hospitals. Some of the pieces are not brilliant, even borderline snarky. But Berger’s introduction is tantalizing as he speaks of those of working inside the places: “They cope with reality in both secular and religious terms and they find ways (not necessarily coherent theoretically) of applying the two discourses in different parts of their lives. Is that feasible? We already know it is. The interesting question is how it is done! The question suggests a fascinating research agenda.” (Society, October 2015, Volume 52, Issue 5, pp 410-412)

Last week the learners of Stakeholder Health convened in the Garfield Conservatory in West Chicago, which for more than a century has protected space for the flowering of learning about plants. Its human story is as exotic as the plants, especially how they won’t quit when surrounded, literally, by gangs or rapacious politicos. Or when only a year after the massive dome was built, thousands of panes of glass protecting the tender palms had to be replaced because the wood frames were rotting (cheap wood). You’d think God would protect arboretums along with fools, but it turns out not.

It often takes a learning community decades to flower, especially when the questions outlast the curious. Jerry Paul, who led Deaconess Hospital in St. Louis and then its equally faithful foundation, formed when the hospital was no longer needed and lent his intellect to the founding of ARHAP, died suddenly in May of fast-moving cancer. Steve DeGruchy died in fast moving water before he even wrote his real book. Larry Pray has lived through another and then another and another stroke stealing his memory even as his spirit is defined by poetic appreciation for life. I’m not so young myself.

Faith is a fellowship, not just a bundle of ideas; marked more by with, than what.

We find life in the questions that outlive our answers.

We are defined by those with whom we seek.

We are what we find in each other.

We are what we think about and how we help each other learn.

We are what we ask of each of other.

We are what we notice in other groups also finding their way, by how we lend and borrow.

We are not the first or smartest humans to do all this.

We find nobility in humility before faith and its mysteries, complicities and community formed and still forming across the years.

It’s Sunday morning after the two big storms have passed; I think I’ll head up to church.

Improbable Lessons

This palm was planted at the Garfield Conservatory in 1926. It takes time and tending over generations to get something like this. — This palm was planted at the Garfield Park Conservatory in 1926. It takes time and tending over generations to get something like this.

Between Pope Francis and the nine Charleston “Saints” whose deadly witness held us just as rivited a few months ago it is obvious to all that faith is not synonymous with stupid, mean and irrelevant. They are helping us see through the stars, bars and blather to something real. If you need forgiveness, intelligence, mature compassion, it is a reasonable idea to look toward an institution where faith has been nurtured over a few centuries, or, in the Pope’s case, millennia. If something lasts longer than one lifetime, or even a season in one lifetime, it is likely that there is a tradition involved, ecology not just of one, but many institutions. The Pope, for all his evident virtues, did not invent or elect himself to the role of Pope. The very institution that has been so egregiously, yes, criminally, complicit with some of the worst imaginable abuses of power and privilege turned around, found its best possible self and—who could imagine it—found a guy to fill the role that has electrified the nuns, nones and nearly anyone with a heartbeat. The Saints of Charleston who died–and the hundreds more that lived to forgive–were not a random gaggle of what really good people, but a fellowship born and formed with those easy-to-dismiss rhythms of bible study, song and prayer that turned out to be—when tested on a horrible afternoon—to be stronger than speeding bullets.

The Zaban Room at The Carter Center has held hundreds of creative, improbablyy hopeful meetings. This one anchored by Ray Fabious, CareNet and Ron Mandershieim on integrating Spirit into Population Health. — The Zaban Room at The Carter Center has held hundreds of creative, improbablyy hopeful meetings. This one anchored by Ray Fabius, CareNet and Ron Manderscheid on integrating Spirit into Population Health.

On Wednesday a small group of experts in behavioral and population health gathered at The Carter Center (named for a Baptist deacon who knows about formation even unto the edge of death). The “we” included Ron Mandersheid and Ray Fabius, who has literally written the textbook on population health (second edition!) before most of us heard the term at all. He was with us after gaining specific permission from his mom so that he could travel on Yom Kippur, a day held sacred across not two, but four millennia and counting. Why? Because the subject was how to integrate the sacred, the Spirit, into the work of behavioral health as it is integrated into large-scale population scale programs. One of the questions alive in the room was how to accelerate and shift “health” from being all about disease and preventing toward the positive dynamic we hope for.

What does “faith” know about that, given that from the outside, the institutions of faith seem to be mostly about not doing things? What does faith know about life that could be integrated into—maybe even illuminate—population health? The answer isn’t in the tricks of faith-based behavior modification that drizzle a bit of ritual razzle-dazzle over the dreary goop that “wellness” programs use. It is about the practices, disciplines—traditions—that shape we humans over the complexities of life together on this spinning and wobbly planet. Those traditions help us adapt to unpredictability, with a huge toolbox relevant to failure, forgiveness, resilience and hope. And the traditions themselves adapt—as Pope Francis is modeling in real time brilliant humility.

Dr. Kimberly Dawn Wisdom of Henry Ford Health System is one of the springs of intelligence within Stakeholder Health.

While the Pope was doing his best to tend to America’s soul one Speaker at a time, the leadership of Stakeholder Health was working in Chicago, where the FaithHealth movement was born, reborn and reborn many times, with another FaithHealth infant in the birth canal as I type. Stakeholder Health is a learning group of those who are living institutional lives, trying to find the shared intelligence, courage and community needed to nurture another round of transformation. What we want to learn the most is how to find and release the deep practical nobility found in the birth story of these hundreds and hundreds of faith-inspired healthcare organizations. Stakeholder Health includes a number of institutions that are not faith governed. Some of those, like Henry Ford and Nemours, spring from the social conscious of a vastly wealthy industrialist; others like ProMedica, MultiCare or Kaiser, express another community of social imagination. But all of us know we are drawing on more than our own toolkit of techniques and clever people. And we know we are doing so for a greater purpose than ourselves. All of us have an ear for the inconvenient cries for mercy rising up from the streets and neighborhoods we were born to serve. We know—as does anyone who has ever attended a church committee—that our institutions are deeply complicit with the banal evil of every status quo. Yet, we also know they are capable of nobility and of giving the moral energy of thousands of employees and their partners a chance to express itself at a scale unimaginable by one, two or a group of individuals.

This is what a man looks like, paralyzed as a teen-ager now giving his life twenty years later to interrupting the cycle of violence: "don't tell me you're too tired." — Levon Stone is what a man looks like: paralyzed as a teen-ager now giving his life twenty years later to interrupting the cycle of violence: “don’t tell me you’re too tired.”

We heard about the miracles born of wrenching change—the closing of Advocate Healthcare’s Bethany Hospital—with angry wounding community protests about broken trust. Out of which came the Advocate Bethany Community Health Fund, structured for transparency and partnership, to steward a million dollars a year into carefully defined West Chicago neighborhoods to strengthen the non-profit and faith organizations closest to those tough streets. We heard the radical simplicity of CeaseFire Chicago, which blends the power of ER chaplaincy (embodied by Richard James) with the brutally won integrity of one who has lived the life of violence and its paralyzing fruits (embodied by LeVon Stone). The “golden hour” is that which follows the bullet’s impact, doing all to break the cycle of retribution. If not forgiveness, maybe grace, at least resilience. It doesn’t always work; but it is almost the only thing that does work.

Dr. Carrie Nelson and Dr. Bonnie Condon unpack the complexities of aligning thousands of physicians for the health of the community.

And we learned from Dr. Carrie Nelson of the mammothly hopeful and excruciatingly complicated task of turning 4,500 Advocate Health physicians toward the work of health in exactly the same way that got Ray Fabius on the plane to The Carter Center. How exactly does that come to be, not just outside the walls of the hospital, but also outside the doctors’ exam rooms and maybe even on the streets in between?

We learn of each other’s best attempts, still caught and partial, filled with frustration and inertia. We become braver, not just smarter. We look at our little lives and decide to risk our reputations as professional grown-ups on things that have never yet worked before. So, all across the vast warren of Chicagoland streets, dozens of hospital are working together to coordinate their community health needs assessments, struggling with the insane arcana of cleaning and aligning data so it can be made coherent at large scale (sort of like making oil and watercolors blend in one painting!). It seems just impossible. But then it is possible, at least enough to encourage those in the heart of it to try a bit harder, to invite a few more partners (let’s paint with acrylics, too!). It isn’t smart enough, yet. But certainly wiser than anything ever before.

Even naming a collaborative learning document with seventy authors is hard! Stakeholder Health will find a way.

There are some thing that one can absorb by listening and others that only become known through the laborious process of writing. And some by the even harder process of collective writing. Stakeholder Health is working on a second “collaborative learning document” that can help us name and claim the land we are in now. We wrote the first before the Affordable Care Act had passed through the valley of shadows known as the Supreme Court. We are in a truly new place drawing hospitals over their institutional moat and public health into partnerships only dimly imagined (with hospitals????). Stakeholder Health knows that one of the greatest and most hopeful unknowns is whether and how the quiet innovations among congregations and faith networks can be woven into the fabric. Like weaving behavioral health and Spirit (surely, we can do this!), weaving congregational intelligence and energy looks obvious until one tries. Even in Memphis where it has been nearly institutionalized, it has failed to become adapted across the full spectrum of competing hospitals (or competing faith ministries!). We need to learn more and far more quickly about integrating the full spectrum the hopeful arts of faith and health. So we are writing a not-book quickly emerging from the field, ready for the field with ten (or is it 11) chapters marking our learning edges.

This is holy and profane work, the only kind we get to do on this planet. It is the only kind any humans have ever hoped to do. We think in these days of Dr. King’s hopeful counsel about the arc of history bending toward justice.

Martin Luther King as a potential student to Colgate Rochester Seminary, long before he came to know of arcs of history and mountaintops.

Gene Matthews, who was the General Counsel for the Centers for Disease Control ended the recent meeting of the NC Citizens for Public Health with the quote behind Dr. King’s quote. Among his genius was King’s eye for the shards of wisdom born of previous battles, this one given in 1853 by Theodore Parker to a Congress on Abolition, an earlier chapter of the work still calling us beyond disparities: “I do not pretend to understand the moral universe;

The arc is a long one, My eye reaches but a little ways; I can not calculate the curve and complete the figure by experience of sight; I can divine it by conscience.
And from what I see, I am sure it bends toward justice.

Trellis

The Surgeon General of the United States explains why his four biggest opportunities to advance health need relational infrastructure built on faith and community partners.

On Wednesday and Thursday this week, a wildly diverse group of leaders met in the White House to explore how to accelerate the growing alignment so necessary to advancing health and well-being of communities. Surgeon General Murthy laid the foundation with a sketch of a framework he will unwrap later this week in detail. But you could guess the outlines, which are pretty much the same priorities John Wesley laid out in his book, Primitive Physic, years ago, written before germs were invented. The reason this is new today is not because we have a new machine, but because have the possibility of new relationships of high capacity, capable of operating at scale. Keep saying that: building capacities for scale. They require what is now possible; rich interconnection between systems for food, mobility, the more complex systems of legal and illegal substances and the almost infinite array of systems relevant to emotional and mental balance. Oh my!

The challenge is the opposite of what you’d think: too many partners, not too few.

A trellis fits the plant it is intended to help find the light. Plants just need old sticks.

Tom Peterson tells me there are at least five million non-profit organizations in the world today, most of them created in the last half century, and almost every single one formed to do something somebody thinks useful for improving their community. It’s worse than that! Many more millions of for-profit companies have been formed in this same time, hoping to make money, but also to do something good in the process. Just check out kickstarter.com to get an idea. The ecology of human forms of association is rich, complex, interconnected and adapting at the speed of electrons. This is terrific if you need lots and lots of relationships. It is daunting if you think someone should be in charge of organizing them.

The Surgeon General does not aspire to organize 5 million of anything. But he does hope they (we) can organize ourselves in ways that can make it more likely that 21^st century science (including, but far beyond everything Wesley knew about) can get into the lives of people and neighborhoods.

Many trellis builders think a lot more about their wooden art than they do about the plants.

One idea that has been popular, but rarely successful, is forming a backbone organization to achieve “collective impact.” I think it’s the wrong body part for the job, preferring something more like the intelligence of the liver or gut. But it is often useful for relatively small problems with simple answers, such as building a lot of homes in a particular city. When used for big and complex challenges, the backbone is often overwhelmed by all the partners and ends up simplifying things by leaving new ones out. The backbone’s limited number of vertebrae is the same list of privileged partners that always end up around the table. The idea of a table at which things are decided is part of the problem: you can’t fit 5 million people around any table.

On Thursday we tried on a different mental model better suited for organic complexity: the trellis. A trellis is not a miracle; it’s just useful to support the miracles of photosynthesis so that plants do what they want to do—bear fruit. The gardener (and the movement organizer) trusts the process, but doesn’t make the process do all the work. I like wine, and know that good wine needs just the right soil (developed over many thousands of years) and just the right rain (which depends on picking just the right valley and sun, not too hot and not too cold), so that magic happens. But it helps if the vines don’t just run every which way on the ground, so they have developed a near science of trellis design to fit different grapes.

Some trellis are built for the decades the vines mature through.

A movement is more complicated than grapes—and right now we have vines running every which way. It would help if we did the humble work of building some trellis on which could grow a rich array of relationships to bear the fruit the Surgeon General imagines possible. There are four main kinds of trellises:

Conceptual. Stakeholder Health emerged as a learning group, which collectively created a monograph to map the conceptual trellis on which healthcare systems could fulfill their missions. It is really good, but like other kinds of conceptual trellises, it needs to be rebuilt for a new season of work (stay tuned on stakeholderhealth.org). The learning community will need to be much larger and even more interdisciplinary than the intellectual gaggle that did the first one. It will need a relational trellis on which grow (and prune) those fruitful concepts.
Programmatic. The Surgeon General’s call for broad activity is not a call to do 10,000 different things, but to find alignment around four that could be transformational. Thousands of us can find a coherent role in food and we can understand our work as linked. Nobody is exactly in charge of it, but a well-built programmatic trellis helps us we can find power and meaning in contributing to a very large collective change.
Institutional. The YMCA is 3,000 local organizations, which have changed quite radically from the original shelters for young men to today’s iconic role as suburban fitness conglomerates. Now it is changing again, to embrace its extraordinary role very aligned with the Surgeon General’s vision. There are many other examples of old structures finding new relevance. But in every case, it is tough work. The 3,000 Y’s have 900 local Boards!

Some plants (like some types of congregations)(yours, Michael Minor!) are so smart they can grow up a string. But the string still needs some support.

Michael Minor is the midwife of the National Baptist Convention’s 60,000 congregations move toward health; but every one of them has its own Board of Deacons that will need to catch the same wind of the Spirit. So, too, the 33,000 United Methodist churches, hundreds of Jewish Community Centers and dozens of faith-based hospitals. “Can dry bones live?” asked Ezekiel. Can an old trellis bear new fruit?

Narrative. We humans live by story, far more than objective data. A movement with capacity and scale needs a narrative trellis, so that each of us, in our many roles as members, leaders, citizens and healers, can locate our personal story in the thread of a great story. We need the bards, writers and artists to help us tune ourselves to resonate to a greater tone.

Community Health Assets Mapping, here led by Teresa Cutts, makes visible the assets already alive in a place. This enables the community leaders to imagine a new kind of trellis of relationships. And then they can build it. — Community Health Assets Mapping, here led by Teresa Cutts, makes visible the assets already alive in a place–the stuff that wants to grow. This enables the community leaders to imagine a new kind of trellis of relationships. And then they can build it.

We watched the video of the murmuration of the starlings, a mesmerizing image of complex beauty (here). Are we like starlings? They dance in the sky forming patterns beyond words. But they are all starlings and know how to act with each other. We are not alike (Kirsten Peachey said the group is more like a dozen starlings, and a hawk that eats starlings, and a horse, pig and potato). Not as pretty in motion. Or maybe it just takes time to find our common energy. The International Science Times, reflecting on the video, says that the way the birds dance is managed “by constantly avoiding collision. Generally, they were taking their lead from the bird directly in front of and below them, rather than the birds to the sides or above.” If you can’t understand how that metaphor applies to humans, you have never tried to lead a committee.

And we watched a YouTube video about how reintroducing the wolves in Yellowstone are changing not just the wildlife, but birds, berries, beavers and the flow of the rivers—the whole ecology (watch it here). Maybe we can change more than we think! So we howled (literally, we howled, which may be the first time that’s happened in White House since Andrew Jackson let in the rabble from the streets!).

Arvind Sindal used his many creative meeting structures to unleash a torrent of transparent brilliance. This is the "fishbowl" with healthcare providers in the middle. Pretty smart, but the questions from the outside were the real brilliance. — Arvind Singhal used his many creative meeting structures to unleash a torrent of transparent brilliance. This is the “fishbowl” with healthcare providers in the middle. Pretty smart, but the questions from the outside were the real brilliance.

Or maybe we are just human grown-ups influencing our own complex systems as we try to live our way into the new possibilities. Many of us this week find our story in the Great Story of faith; we think we are agents of a redemptive process that has never quit, despite entire centuries of bleak reversal. We think that God is not quite done with our tiny planet or even with us, flawed and tiny people.

As we were meeting, astronomers were reporting more evidence that the ingredients for life are astonishingly abundant in places beyond counting at distances beyond imagination. The vast reaches of reality are swirling with the ingredients of life. The places once imagined as impossibly cold and hostile are just waiting for the right relationships to emerge. “Life finds a way,” said Jonas Salk, who was one of the first who thought that life rode into Earth on the comets.

Life is still finding a way—even in the hostile barrenness of Washington DC. It turns out there is a richer array of the basic ingredients than we’d been led to expect. But don’t make the process do all the work, unless you have a few million years worth of patience to move at the speed of stars.

I turn 64 Monday and need to pick up the pace a bit. It is very good news that we don’t need to invent the life. But we do have to thoughtfully craft the trellis. Let’s get on with it.

Carolina tears

Sprouts find their way through the bullet holes in an old refrigerator in North Georgia.

Hearts break today in North Carolina.

I think of atheists as slightly over-educated modernists who are harmless, almost quaint, in their ardent non-belief. It had not occurred to me that non-believers were inclined to shoot people over parking slots. But now the Associations of Non-Believers have to explain, just as we Baptists have had to do for centuries, how their style of belief in UnGod can make one mean enough to be kill.

Of course, Atheism doesn’t make you mean any more than Islam, Christianity, Bhuddism or Hinduism. But every one of those structures of meaning have given harbor at some time to dangerous people who kindled the energy of belief into the fire of violence. Belief—and unbelief—can warm or burn.

Someone who believes in nothing is indistinguishable from one who says they believe in God but who do not believe in what that God tells them to do toward others. Groups of people, whether Islamic or Christian, can claim to follow God, but actually believe in their guns, banks, drones or grinding, blinding anger.

No French cartoonist, or student trying to park their car can be entirely safe from delusional nutters. Mental illness often hides in the fog of ardent belief and unbelief. It deserves pity, prayer and, often 21^st century pharma. Turning this man’s delusions into a reason for religious or anti-religious rant only serves the demons.

The most dangerous nutters are the ones who gain control over the instruments of state power. The mentally ill man who shot three students in Chapel Hill is not as scary to me as the elected wackos 25 miles away in Raleigh where an unhinged legislature is considering a bill to prevent Muslims from imposing Sharia Law on the good Christians of Northern Carolina. These guys have a whole police force, not just some guns in a closet. They don’t want your parking place; they want the whole enchilada.

We Baptists remember times when we were strangers in this land, too, and know to fear any government that thinks it is holy enough to know who to punish on behalf of God. The first duty of any Christian—or believer of any other faith—is to work to make their own faith safe for the world and especially for anyone who does not share your faith. You or your children might be a refugee someday, too. This is why every religion that lasted longer than a few seasons raising high the priority to care for the stranger, the weak, the poor, the widow or motherless child.

The actual followers of Islam who pay taxes here are mostly students and a previous generation of students now serving as our doctors, nurses, dentists, computer programmers and anchors of our civilized way of life. There is no clinic or hospital in the entire state (or any of the other United States) that could operate an entire week without the medical professionals from many faiths well beyond my own Christian circle. Our community strategy of “proactive mercy” depends on the powerful faith of saalam-seeking healers of Islam. So our grief extends to the families and friends of the UNC students in a double portion because we share their commitment to the healing arts their entire family so obviously embraced.

I’m a Christian, trying to follow Jesus. He said that God would sort out the right and wrong, sheep and goats later on. The twisting plot of the story made clear God’s decision would surprise everyone involved. Don’t guess God. In the meantime, love mercy, do justice and walk humbly.

Cry with us and lend us with your prayers of mercy.

City of Light

Carolos Latuff, one of hundreds of visual jounalists speaking into the horror of Paris.

Every religion is dangerous. Like fire, wind and water, religion is a fundamental element of human life that can drown, blast and burn. Religion guides our fear and frames our shame. And it can also strengthen our capacity for the courage shown in generosity, compassion, kindness and decency. It can be a wicked brew and also be like warm French cider on a bitter Winter day.

What are those of us who find our hopes in faith to do this week? What do we do when faith has been the language for nearly unspeakable acts? Do we just huddle behind the soldiers, or is there any place for our own actions to be as brave and relevant as the cartoonists like Carolos Latuff poking his pencil into the muzzle of terror?

Can mercy be brave as violence?

Although it filled up the CNN cash register this week, violence between religions is relatively rare and getting more unusual year by year. I’ve quoted the finding of Daniel Pink in earlier blogs, but worth remembering that all forms of violence continue to decline year over year over year. Most religious violence is between those who share a religion but find its variations deeply threatening.

While dozens died in Paris because of their secular differences from Islam, hundreds, probably thousands of moderate Muslims died last week because their 1,500-year-version of Islam embodied the radical hospitality, kindness and sacrificial generosity that fills up the pages of Islamic sacred writings. This is true of every religion. John Calvin burned–literally set fire and watched die–Christian theologians that it would take another theologian to figure out the minor differences in doctrine they were arguing about. He killed Christians not Muslims. I’m a liberal protestant writer who not have survived a week in Geneva. I thought about this when worshipping down the hill from Calvin’s towering grey church with an ecumenical gaggle of english-speaking Christians last July. He would have locked the doors of the World Council of Churches, torched the whole place and everyone in it….and than sung a hymn about it. And Presbyterians are relatively nice people. I’m a Baptist…….which I’m just guessing is more common among the Klan than their up-market Christian cousins.

It is always safer to have a radically different idea about god than a moderately different one using the same language. ISIS kills many more moderate Muslims more eagerly than Christians or those who believe in no god at all but humor. Every now and then they may travel to Paris for some especially flamboyant act of horror. But their every day killing is focused on the vast majority of fellow Muslims they find nearby who understand Islam as a faith of mercy and healing.

There is not much a Christian can do about radically violent Islam. But it would help to avoid accidentally strengthening the most despicable by implying they know anything about Islam. The “terrorists” aren’t radical about Islam, which is a religion of hospitality and charity; they are radical about their own projected fears, insecurities and delusions which are then wrapped in a weird and horrible way in the vocabulary of Islam. Christians know all about this process. Christian politicians are masters at wrapping their reptilian greed with Jesus’ words. But we don’t say of our nutters “those folks who blew up the Federal building in Oklahoma sure were radical about following Jesus!”

Do something to strengthen the moderate Muslims, for whom this is a special time of danger, not only from their traditional nut-cases on the far boundaries of Islam, but now from those of other faiths, including secularity, that will fear anyone they think is a Muslim no matter where they’re from (including Sikhs who stupid Americans confuse with Muslims all the time because of their turbans)(Oh, good grief…..).

TC and I took a check over to our friends at the Muslim Free Clinic on Waughtown Street that I’ve mentioned in my blog before. They were today, as they do twice every month, caring for whoever walked in from the neighborhood that needed healthcare, medical counsel or a clue about where to their pill prescription renewed. It is very mundane, as most mercy tends to be. The physicians and volunteers show up and do it because their faith has thought them to do so. They aren’t aiming for martyrdom; just happy to settle for basic grown-up integrity. They are, as a Christian philosopher once said, “grabbing the near edge of a great problem and acting at some cost to themselves.” It is all a Christian, Muslim, Jew, Sikh, Bhuddist, Zoasterian or cartoonist can hope to do with their lives.

Do this.

Soak in the TV, then turn it off and go find someone who isn’t of your tribe, class, color, faith or opinion and be kind to them in some practical way.

Do this.

And the God known by every name any human has ever uttered in hope will heal your fears and count you among the living.

Do this.

New blade

Six decades later I can still hear the screaming whine of this saw as my dad crafted cabinets with it.

I peered through a hole in our basement wall into a cloud of sawdust where my father fed a piece of wood into the spinning blade. The sound was painfully high loud and powerful, such that I can still hear it, now almost six decades later. I was two or so and learned later the wood was pine, as was all the rest of the cabinets in the home I grew up in, crafted with a mixture of love and parsimony by Dad. The saw, made by Rockwell, eventually became mine and used for most of my adult life as I, too, ripped, spliced, joined and paneled every place I’ve landed. The saw was a primal link to Dad, but over time whined, smoked and wobbled more and more. Once, back when I was earning my living with it doing remodeling, I was moving it from a job site when it bounced out of my nearly-as-old pickup truck, breaking on the pavement. Ken Sehested, knowing my despair, found a friend to weld the key cast iron gear back together, so it lived to wobble on in my life. But eventually the damn thing could no longer hold an angle, sometimes cutting a perfect 45, but more likely 50 or, the other day, 60 degrees. This makes very ugly joinery.

Now wobbling, smoking and whining, the saw prevents, not enables, good work. Dad would not be happy.

Dad would have hated the crappy quality the saw made inevitable and surely would have found any link with him something of an insult. I finally had to distinguish between clinging to nostalgia and actually honoring my Dad’s woodcraft. So I went to Lowe’s, channeled his spirit, and bought a solid Kobota table saw. I’m in the last stages of a new bathroom in TC and my condo near Old Salem and now have a chance at doing the finish work in a way that the Moravians and Dad would find acceptable.

Our lives are filled with the artifacts of those in whose shoes we walk, feeling our feet slightly too small for the journey. Just before Christmas I met with the ethics committee of the medical center, which had been established by the iconic surgeon, Eben Alexander, decades ago (he’s the dad of the recently famous one who wrote about “proof of heaven.”) The committee he started is still appointed by the chief medical officer, also a surgeon. Although medicine and the health sciences are less and less about what happens inside the medical hotel called “hospital,” the focus of the ethics committee continues to be almost entirely at the surgeon’s elbow. It thinks mostly about what the doctor should do or stop doing. Our current model of bioethics is not looking at the CFO’s spreadsheet, or COO’s deployment plans, or the Board’s capital decisions voting millions to build another office in the burbs, even those decisions shape the life and death for thousands of people over time. One can imagine Dr. Alexander shouting, “I started it; you go the next step!”

Surely dad is glad I finally put down the nostagia and picked up a decent tool for work that honors him. — Surely dad is glad I finally put down the nostalgia and picked up a decent tool for work that honors him.

Every nook and cupboard among the health field is filled with guilds, national associations (with local chapters!), honoring this and that habitual practice and committee that made some sense long ago. They all have founders and officers—and sometimes even endowments(!)—but have long lost their capacity to cut cleanly or make useful connections. They have not moved with the science that gives more and more power to the integrated strategies managing conditions over time outside the professional enclaves. We live a long time now mainly because of better food and pharma not because we get surguries frequently. So there are way more ethical implications in the price of drugs than when or whether a surgeon does a procedure. They obstruct and no longer aid the joining of good science to good intentions. We need to honor our moral legacy with a new set of intellectual tools nearly as much as I needed a new saw.

We honor those who have given us life by acting with the creative courage they showed in their time; not by doing the same things their courage demanded then, but doing what courage demands now. We grown-up humans build things out of brick and steel. And we craft habits and patterns of power that guide the flow of money and time to the new glass towers. All these artifacts look solid and lasting, but they are as blowing sand at the beach.

Twice a day the tides wash the in-between land of the marshes.

I am typing this at St. Helena Island, South Carolina watching another morning tide move another day’s load of sand a few feet up the shore. These are called barrier islands because they protect the vital salt marshes which the tides wash twice a day, nurturing its wildly generative life. Very little important happens on the beach; all the life stuff happens in the muck and goop where the shrimp and a zillion other things are born and nurtured before heading to sea. The sand islands protect this vitality because they constantly move and adapt dynamically to the next big storm and even the next shift in climate rising the level of the seas.

Old maps tell the tale: the beaches move; the marshes live on.

In the handful of centuries white humans have settled here, the islands have moved miles. From the top of the 132 foot high light house you can see a few miles to the waves north east where the old one once stood. This new one (1889) is built to move again. Geologists know the whole chain of islands have moved back and forth for millennia. They last because they are dynamic; they serve life because they change. They are like tools built for a season of good craft.

The scope points 8 miles away and a quarter mile off shore where the lighthouse once stood.

Those of us holding positions of influence in institutions like to think our work and our organizations are the key to the life of our communities. Smart people at Stanford play to this pretense by suggesting adaptive change is dependent on “collective impact” organized by “anchor institutions.” These ideas are not just wrong, but dangerously misleading. Living communities don’t need to be impacted, but nurtured; they don’t need more anchors but heart, muscle and guts that serve movement. They do need protection from the raw tides, heavy winds and bitter storms, but protection in the service of change, not protection from it.

What else does any leader have to do that protect the creative energy so that it generates life? Do we have something better to do than that. Whether we are stewards of a church or hospital or public health agency or community health center, the life does not come from the edges, but the heart. I learned in Memphis that if I could protect the creative space for those who usually don’t have much power, they would craft beautiful and useful structure perfectly joined to the possibilities the neighborhoods needed. That process is the “Memphis Model” not the specific apparatus that emerged at that point in time. Don’t confuse the craft (mercy and care) for the cabinet (the structure) and certainly not the wobbly saw (me).

Leaders give life a chance by protecting the generative spaces in which life emerges, especially when those spaces need the complex processes over time. Any human community is way more complex than any salt marsh.

This is almost exactly the opposite of the role big institutions want to play. The leaders of the big things like hospitals can always rent consultants who are happy to tell us to tell the neighborhoods how they should live and how they should change, not us. The model for this is the old way that beach engineers tried to build concrete barriers to stop the tides and the natural shift of the sand (sort of like the one now under 40 feet of water a quarter mile from shore). The more we think like anchors, the more we’re in the way of life, which will most certainly have its way with us.

Roots are a kind of anchor that serve for a time and then not.

This is why I find surprising hope in the small stirring of faith and faithfulness in the faith-inspired healthcare systems of Stakeholder Health. Just about the time when you think smart and cynical are the same thing, along comes life to surprise us. In reality sometimes, large institutions such as foundations and hospitals can provide some shelter amid the raw power of the market forces (the “hurricane” in my extended metaphor). We can be barrier islands against the forces of raw money power, preserving the neighborhoods’ function as the salt marsh where life flourishes and creates the next generation. It actually does happen sometimes. It could happen more.

Francis Rivers Meza, one of our faculty in the FaithHealth Division, shared an article by Patricia Fernández-Kelly (2012): “Rethinking the deserving body: altruism, markets, and political action in health care provision,” in the journal Ethnic and Racial Studies. (click here for the article). She explores the way that religious organizations, including the huge ones such as hospitals, sometimes choose to act against the logic of the capital markets, providing crucial buffering for neighborhoods of poor and often stigmatized people. And they do this on purpose with craft and skill year after year. The authors cite one of our stakeholder health friends, Baptist Healthcare of South Florida and their long term work in Homestead Florida, a place that knows all about the need for barriers against storms.

Life finds a way, Jonas Salk liked to say. Jason McLennan, writing in Yes! Magazine this month says, “If there is one thing that’s certain, it’s that the future hasn’t happened yet.” Bingo! Honor both past and future by helping life finding its next way, not by protecting our old way.

The lighthouse just across the inlet above the gull. Everything moves; life finds a way.

Sin and Liberation

Didn’t expect that title did you? liberating structures

There is something about Good Friday coming in the same week as a day-long medical center budget meeting that turns my mind toward sin; and then, just when you least expect it, toward liberation.

Tom Peterson of Thunderheadworks turned me onto the book The Surprising Power of Liberating Structures by Henri Lipmanowicz and Keith McCandless in his brilliant blog about social change (http://www.thunderheadworks.com/liberating-structure/ ). The book is the fruit of years of work by a way smart group of social change-makers focused on making meetings and events smart and liberating. You may have noticed that most organizational meetings are not very liberating indeed, usually deadly.

Human gatherings can be powerful if built on their 10 basic principles and then artfully crafted with some of their 33 tools. It is easier and more natural than it sounds, because we are built for liberation. We use these tools in many of our FaithHealth trainings and retreats. We will use them in the Stakeholder Health Chawumba event in July (http://stakeholderhealth.org/chawumba/ ). We are looking forward to one of the masters of the craft, Arvind Singhal, being with us next month to teach us in person.

The ten principles of Liberating Structures in the book The Surprising Power of Liberating Structures by Henri Lipmanowicz and Keith McCandless.

The point of all this is not better meetings but a whole new world.

As soon as I read the principles I recognized what I experienced in Memphis through Bobby Baker, Chris Bounds and the hundreds of practical geniuses on that tough ground. The Memphis Model wasn’t just liberating meetings; it was a web of liberating relationships built over time in structures held together by trust. As Bobby would say, real work, not show.

The liberating relational structures of Memphis,–and now North Carolina–aren’t happy accidents. They are built on purpose for the purpose of setting people free from the bondage of what are usually called “social determinants” by healthcare professionals. Things like poverty and broken families are bad enough, but are especially insidious when experts believe they are so powerful that they determine lives. Left to drift, the patterns and privileges of race, wealth, education and law will replicate overtime with the predictability of gravity. However, social factors do not determine the future if a community builds liberating structures strong enough to bend Dr King’s “arc of history” toward justice. Humans can stand up on two legs and walk—even run and jump. But we have to choose to do so. And we can invest our time and resources to new relational architecture, but we have to choose to do so.

Do I even need to point out that budgets usually give in to organizational gravity? How often do you see a liberating budget? (Please don’t mention this column to anyone remotely linked with Wake Forest until after my Division budget closes in a few weeks.)

This gets us to sin, specifically the “deadly sins” of the health industry . Catherine Panter-Brick and Mark Eggerman of Yale University and Mark Tomlinson of Stellenbosch University have just published a bold piece in Global Health Action sure to generate a storm of uncomfortableness by looking at the field of global health through the lens of sin and virtue language. They are looking at global health, but every syllable pertains to the healthcare organizations in the United States that usually don’t think of ourselves as part of the world. The authors are tough: “Structurally, global health has broken faith with its core ethical mandate of addressing the root causes of poor health outcomes, falling prey to four main temptations—coveting silo gains, lusting for technical solutions, leaving broad promises largely unfulfilled, and boasting of narrow successes. These are capital sins in the sense that they engender serious misdeeds and careless misdemeanors, and necessitate a change of heart.” Sin does not get the last word, for there are cardinal virtues, too: “A sharper focus on values and dispositions—aligned with the cardinal virtues of justice, courage, prudence and restraint—is needed to transform global health action.”(http://www.globalhealthaction.net/index.php/gha/article/view/23411 )

The opposite of sin is liberation, which needs the human structures so that the waters might roll down into the parched lands as every prophet for several millennia has envisioned. Earlier this week some of our FaithHealth staff borrowed a church bus and road the tougher streets of Winston-Salem where our data indicated many of our “charity care” patients lived (those are Leland Webb’s ears). Even those of us who are strangers to these neighborhoods could see what is missing that determines so much suffering. We expected that. We were more surprised that once you get out and look, it is actually not hard to see the abundance of assets scattered in the very same neighborhoods.

The scattering of good works has not managed to achieve justice, of course. It is never wrong to give a bag of food or box of meds to someone in need. But surely, it is sinful to be proud of the narrow services that merely ameliorate suffering when so much more is possible—Panter-Brick’s uncomfortable point.

With some some humility (another virtue!) we can imagine liberating relationships that are not there, yet, but could be, if we applied art, discipline and time to bringing the possibilities to life.

Morning Star Missionary Baptist Church, a vital health asset co-led by Rev Charolette Leach, one of our CPE residents at the Medical Center. It sits only blocks from apartments considered to be the epicenter of hopelessness.

Could we imagine new structures, pathways and patterns that would amplify freedom and responsibility? Of course, we can. We just have to choose to do so.

It is impossible to think about sin and liberation this week and not notice that the whole point of Easter is that life breaks out where you least expect it; where you had given up all hope. Spoiler alert: he is alive and we are free. Why are you still satisfied poking around in the tomb among the dead?

Mapping Curiosity

These are such interesting days for hopeful people in our wildly dynamic world. Never before in the history of the species have we seen more radical emergence of vast numbers and forms of relational webs. More than two million non-governmental organizations have emerged in the last quarter century. Most of those are now morphing into a complex ecology of financial forms, mostly somewhere in between the old distinctions of faith, government, non-profit and for profit.

The technical name for our current version of we humans is homo sapiens sapiens: we are the creatures who know. And we know we know. I actually think we don’t know….much. But we are absolutely curious!

Jim tells of the curious story of the role of faith in the novel idea of "health for all." — Jim tells of the curious story of the role of faith in the novel idea of “health for all.”

Jim Cochrane leads the leading causes of life initiative. He has long argued that play should be one of the causes of life because from our first breath we poke, explore, crawl, play with our everything we can reach. Yes we do!(leadingcausesoflife.org). In recent months he has pretty much been captivated by…Emmanuel Kant because of the way he places creative freedom at the very center of human capacity.

Hope is possible because we have the capacity to think of entirely new things, and bring them to be. Almost everything nearby you this very moment is product of that creative capacity. The flat screen monitor or iPhone you are reading on which you are reading this are evidence, but indoor plumbing reflects quite a large number of creative moments, too. And there is still profound creativity going on at that end (so to speak) of human process that dwarf the iPhone for life and death significance: check out http://www.peepoople.com/ .

Because it is human, this capacity for creative freedom is social. It is rare for any of us to have a totally autonomous seminal thought of our very own. WE are creatively free, not just me or you. And the root of that social creative freedom is curiosity. When we are young it looks like play, beginning, I think with our body parts: ever watch an infant discover their toes? They are curious about them; study them and then start to figure out. Walking and the long journeys of life come quite later once we learn to talk and read.

We are curious about each others’ curiosity, which is how great creative teams thrive. My favorite new book, “The Surprising Power of Liberating Structures” (www.liberatingstructures.com) is a users guide to the social micro-structures that break and hold open the social space for us to explore what is possible in social webs. What opens up that space is not first imagination, but curiosity about what the group as a whole might discover is possible.

What you know is less interesting than that tickle just over the edge of your knowing just as the eye notices things on the periphery of clarity. The mind notices what moves, quickly ignores anything that stays the same. This isn’t always brilliant, of course. We forget things that matter and are easily distracted. The reason why we have so many rituals and reminders is precisely because we so tuned to what it not known and what might be possible. Nathan Wolfe calls that “adaptive novelty,” suggesting that humans can learn about this strategy for the billions of years virus have used that strategy.

Our most vital relationships and networks form on on a map of our curiosity. This is the terrain we walk from what we know to what we might be creatively free to do. The map of that terrain is rarely conscious, almost never on paper or even scrawled on a wall. Why not invent curiosity maps? Those would be dynamically generative and inviting.

Criterion Institute is a place of such generative mapping, which will be evident as it gathers for one of its astonishing “convergences” in Connecticut this week (http://criterioninstitute.org/convergence/). Later this week a different–but intersecting– map will emerge at the intersection of faith, peace and health at Lake Junaluska in the North Carolina mountains (www.lakejunaluska.com/peace/ ). Meanwhile, Stakeholderhealth.org vibrates with a constant flow of curious new findings about what is possible for faith and mission-driven hospitals to…..do.

Old Salem is still a place where new things might happen.

FaithHealthNC.org is a riot of things nobody thought possible that turn out to be very doable–and that we are creatively free to do. Nobody is planning all of it. We are finding ourselves living on a map of possibilities that is being drawn in real time by unlikely people asking, “what is we did ……together?” We closed the Global Health Symposium yesterday full energy because we were beginning to tune ourselves to the social network emerging from our shared hopes relationships.

Do you want a map of the future? Do you want to know what’s possible?

Map the networks of curiosity. And then live into and on that map with those you find there.

Generating generations

Frankfurt Train Station — Frankfurt Palace of Human Mobility (the train station)

I spent this week with a group of global class scholars and scientists at the Frankfurt Institute for Advanced Studies under the auspices of the Ernst Strungmann Forum (www.esforum.de). We gathered to blend what is known–and not known–about formative childhoods and how they are related to peace. Being modern humans, we compared strategies for how to remember pin numbers, deal with Facebook and early stages of sore throats. And by bringing biology, social sciences, some ecclesiastical and a few UN inclined thinkers into learning range of each other we also found new and very old knowledge about life and how it works.

First, don’t overlook the obvious and known, especially for the first 1,000 days. Do not overlook the critical role of mother. And do not overvalue the role of professionals, especially those who wish to be paid for their knowledge.

Encourage women’s networks that embody the most basic primate intelligence in neighborhoods. What biology wants is that as soon as anyone is pregnant, the neighborhood swarms with touch, food, safety, protection from smoking and toxins, inclusion and secondarily, “medical prehab” relevant for the birth process. They are likely to emerge naturally–as biological as breathing in and out–but perhaps in more toxic or wounded environments may need a kind of social trellis to grow on.

At birth through first 8 months, never let the child be untouched, alone or unattended. Focus on food, safety and avoid stress. Protect the mother and make her aware of her safety and honored role. Protect those bonds that protect the mother-child dyad and honor them, too. Our current measurement tools are too crude to map these more complex bio/social/chemical/electrical webs, but we should assume they are critical as we we wait for footnotes.

From 8 months to 3 years encourage Mother’s clubs, father’s clubs, food and safety, community worker visitation encouragement and connection to other key potentially key assets. Flood the social network with encouragement about their relevance and ensure their connection to other material assets. Even grumpy economists note evidence from Mexico that positive conditions work better than no conditions at all). Remember that we are working with the most fundamental primal longings of the heart (David Olds), not against them.

Don’t medicalize, decenter or denigrate the trusted network around the mother. Constantly feed back to the intimate and peri-intimate social network about their success and relevance, especially as those networks extend beyond the intimate and cross over into more institutional or political domains such as schooling or public health.

Use the encouragements of spirit, ritual, celebration, visioning and honoring that are the strong suit of every grounded faith tradition. Constantly honor the profoundly sacred meaning of the most mundane and practical aspects of the work of protecting the prospects of the child and the next generation. Flood the social systems with positive feedback about its success at each of the crucial transitions in early life journey, especially when that success is achieved against structural violations of poverty or intentional deprivation linked to race or ethnicity.

Jim Lecckman of Yale talks of the synchronous mind.

Can we imagine a virtuous cycle over the next several generations that would tend toward less violence, more ecological wisdom, gratitude, and kindness? Yes.

This would be the natural fruit of a complex ecology of associations midwifed by hopeful people over decades. By complex associations I mean the ever-morphing interconnection of government, academic, faith, health, media, philanthropy, non-governmental and some we don’t have names for, yet, as we become Googleized.

All of these interconnected assets experience will experience increased confidence and stability as they are more conscious of being part of a generative phenomenon of life. Each is dignified by its intimate usefulness, rather like mitochondria are made happy by being utterly absorbed into the life of the cell.

As much as our Larger Life depends on each mother/child dyad, it also thrives with the dawning realization of continuous intergenerativity of infants-children-youth-adolescents-young adults-adults and elders.

All are us –all the time all our lives– play a biological and spiritual part in generating the life and well-bring of each other and thus the whole. Normal life is bio-social-spiritual. And the more mundane the activity, the more completely it is so.

Even the very young notice that their adults can be depended on to act with intentionality in their favor toward their good life as possible. Slightly older, but still-young children notice adults showing the same care for others slightly younger. Older children and adolescents notice themselves beginning to fulfill expectations of playing similar roles at part of the nurturing web and often notice themselves playing a key role in the care of those who are old. And then they experience an oxcytocin bath in puberty as they seek a mate and drive toward their own children.

This associational ecology emerges out of and in tension with–conflict, disparity, tension and wounding. Antonovsky considered the banal violations of humanity as the norm, not the exception. He wrote after the horrors of World War Two on the very soil of which we met. But much of world today remain broken– and still breaking–by active and structural violence. But is it more dangerous than the lion-filled African Savanna which our nomadic bands faced? Probably not. We are not nomads, but can learn from them (notes Doug Fry). Our radically social species thrived because of our complex fluid dynamic human systems as smart and tough as the world. We created social webs safe enough to bring another baby into for about 1,000 generations. This is the human way. Of life.

Looking West from the Frankfurt Institute for Advanced Studies.

If we humans navigate the next century’s difficult passage, it will be because humble leaders will have learned to work with the whole dynamic array of complex human associations to nurture a generation of new generations capable of new generations. We will have found our life in a more complex ecology of human associations capable of creative freedom. This week in Frankfurt–no stranger to overwhelming suffering and astonishing creative freedom–nurtured my hope that we may pull that off.